TREASURY

Child Benefit

Dawn Primarolo: The Child Benefit Bill, introduced to Parliament on 13 December, will enable the Treasury to lay regulations prescribing the conditions under which young people aged 16 and over qualify for child benefit. Draft regulations and a supplementary regulatory impact assessment are published today, to indicate how the Treasury intends to use the powers provided by the Bill. Copies are available from the Vote Office, the Library of the House and the HM Treasury website.

CONSTITUTIONAL AFFAIRS

Mental Capacity Bill

David Lammy: In response to a recommendation by the Pre-Legislative Scrutiny Committee, the Government placed a draft code of practice, accompanying the Mental Capacity Bill, in the Libraries of both Houses on 8 September 2004. Members of the Commons Standing Committee (19 October to 4 November) referred extensively to the code during discussions. Members commented that they found the code very helpful in giving them details on how the Bill would work in the real world. Many Members spoke of the importance of the code for successful implementation and they appreciated the fact that the draft code had been prepared at such an early stage. The Government are very grateful for the constructive nature of the comments that have been made about the code.
	The draft code is a living document. It will change as a result of discussions on it so far, and will change further during its passage through the House of Lords. It will then be subject to a full public consultation. Given the importance of the code, the Government have decided to produce a short summary of the revisions we expect to make to it. This includes changes that will need to be made as a result of amendments to the Bill, as well as suggestions Members made about the code itself during the Commons Committee stage. We have also been continuing our dialogue with stakeholders and they too have suggested some helpful changes. We hope this summary will help to inform Lords' debates on the code by giving them the most up-to-date picture possible of what we expect the final version of the code to look like, before it is issued for full public consultation.
	Chapter 3: Capacity to Make a Decision
	The code already contains details on communicating with someone using simple language,visual aids and other communication aids. The Government are making an
	amendment to the Bill that will set out the steps someone should take to communicate with someone who hasdifficulties in communicating. Therefore we will slightly amend this section of the code torefer to the relevant clause in the Bill.
	Chapter 4: Best Interests
	Chapter 4 of the draft code discusses the best interests principle. The code explains how the Bill's best interests checklist should be used by decision-makers to decide where the best interests of the person lacking capacity lie. Given the importance of this principle, we have decided to expand on it. In particular, we will amend it to make the objective nature of best interests even clearer. We will emphasise the importance of considering all relevant facts and circumstances when assessing what would objectively be in a person's best interests.
	We will include further clarification on the legal status of advance statements requesting (rather than refusing) treatment. This was an issue discussed at Committee. Advance statements requesting treatment are an expression of a person's wishes and feelings and as such are already implicitly included in the Bill and the best interests checklist. But we have agreed to clarify the position on advance requests for treatment in the code of practice.
	If a person has taken the trouble to write down an advance statement of their future wishes, then any treating clinician would have a duty to consider these wishes and feelings as part of the best interests determination. The more specific and well-thought out the statement, the more likely that a clinician will find the statement persuasive within the best interests assessment. We will make this clear in the code.
	Committee members raised concerns about discrimination against the elderly and people with disabilities. If able-bodied people think generally that life for the disabled and for elderly people is less good, this could have an impact on decisions made about these people or the care that they receive. We will therefore amend the code to emphasise that it can never be in a person's best interests to be discriminated against or given less favourable treatment on the basis of age or disability. The code will point out that the Disability Discrimination Act 1995 provides that hospitals, care homes and social services must take reasonable steps to provide people with disabilities with the same standard of service, on the same terms, as all other members of the public. We will also explain that since best interests is an objective test, any subjective views that an individual might hold generally about the quality of life of people with disabilities or the elderly will not be relevant as a part of the assessment.
	In Committee, members raised concerns that the Bill does not make provision for an act done to someone who lacks capacity that is intended to provide a medical benefit to a third party. We will clearly state in the code what is permissible under the Bill. This would confirm current common law that, in some cases, best interests would permit testing or treatment for the benefit of third parties, where it meets the wider interpretation of best interests. The code will give specific advice to guide professionals or the Court of Protection on cases where testing or treatment for the benefit of third parties is at issue. It will clarify which cases should always be considered by the Court of Protection.
	We will also include in the best interests section more information on communication support for those lacking capacity who have difficulties in communicating their wishes. We will make it clearer that all reasonably practicable steps should be taken to help the person communicate his present wishes and feelings.
	Chapter 5: Acts in Connection with Care or Treatment
	The code deals with the duty of donees of lasting power of attorney and court-appointed deputies to give accounts, when looking after the finances of someone who lacks capacity. However, when it talks about carers without formal
	powers paying for goods and services, it does not mention that they should also keep receipts and proofs of payment. We will add this useful piece of advice for carers to the code.
	Chapter 6: Lasting Powers of Attorney
	We welcomed a helpful suggestion that the code could suggest to someone making a financial lasting power of attorney, that they could stipulate that someone else should check the attorney's accounts periodically. We will include this suggestion in the code.
	People will also be able to state in a financial lasting power of attorney instrument that it should only be used when the donor has lost capacity. (Welfare attorneys can only make decisions when someone has lost capacity.) People asked how anyone would know that the donor did in fact lack capacity. We will therefore amend the code to explain that it is the donor's responsibility to explain exactly what he means by this to ensure that any such conditions are workable. For example, the donor could say that the lasting power of attorney should only come into effect when his GP has confirmed his lack of capacity to manage his own property and affairs, in writing.
	The code contains many examples that help to show how the Bill will operate in real-life situations. One example deals with the ability of donees of lasting power of attorney to make gifts on the donor's behalf, and illustrates this with a donee using the donor's money to pay his grandson's school fees. This is misleading, since school fees might not come within the scope of gifts. We will amend this example.
	We will add a further example to clarify an area that people have found difficult. That is, when someone with a financial lasting power of attorney continues to carry out some financial transactions for himself, because he is capable of doing certain things at certain times, but also needs his attorney to do some things for him. The example will make clear that people, such as bank staff, should be prepared to allow both the donor and the donee to carry out transactions.
	Chapters 6 and 7: Attorneys and Deputies
	We received a useful suggestion about the need for clients of the Office of the Public Guardian to ensure the information held on the registers of lasting powers of attorney and deputies is up-to-date. Both the code and guidance issued by the Office of the Public Guardian will state that people should notify the office of any change of name or address of donors donees, deputies and the people for whom they act. In the case of the lasting power of attorney register, this will be the duty of the donor, for as long as he has capacity to do so, but responsibility will fall to the donee if the donor is not able to do so. This will help to ensure that the registers remain up-to-date.
	Chapter 8: Advance Decisions
	The Joint Committee on Human Rights asked why there was no requirement in the Bill for advance decisions to be made in writing. The code of practice will be amended to ensure that it is in line with any changes made to the Bill requiring valid advance decisions to be in writing and witnessed. The code will stress the importance of making the contents of advance decisions as clear and watertight as possible. It will recommend that advance decisions should be made after consultation with a health professional.
	The Committee also asked whether someone would need to specify in an advance decision that they did not wish to receive artificial nutrition and hydration (ANH). The code will make it clear that ANH is regarded as treatment. People will need to specify what treatment they are refusing and then
	specify, in addition, if they wish the refusal to apply even where that treatment is necessary to sustain life. The code will emphasise that those making advance decisions would be advised to discuss it with a health professional who could explain their treatment options.
	Chapter 9: Protection and Supervision
	Chapter nine of the code gives information on detecting and preventing abuse of those who lack capacity. We have accepted the suggestion that the definition of abuse in the code could be extended to include threats to restrain someone's liberty. It is important that the code lets people know that there are many types of abuse and that verbal threats and intimidation may constitute psychological abuse, and we will therefore expand the code's section on this subject.
	Chapter 11: The Independent Consultee Service
	The Government tabled a number of amendments to clauses 34 to 39 on the independent consultee (1C) service. The House of Commons Standing Committee accepted these changes and we will therefore need to amend the code accordingly.
	We have amended the role of the 1C in the Bill from simply advising the decision-maker on the best interests of the person who lacks capacity to more clearly representing the person's wishes and feelings as well. The code will clarify that the role of the 1C will be both to represent the person who lacks capacity, where this is possible, and to give the decision-maker advice and information to enable the decision-maker to reach a decision about what would be in the best interests of the person who lacks capacity. In particular their role will be to give input on the person's wishes, feelings, beliefs, values and other factors.
	The revised Bill stipulates that the requirement to consult an 1C, where there is a decision to move someone lacking capacity into a care home, is triggered when the stay is likely to be for longer than eight weeks. This applies regardless of whether the accommodation is provided or arranged by a local authority or the NHS. (Where an NHS body provides for accommodation in a hospital the relevant period will remain 28 days). The code will reflect this.
	The code will also reflect an amendment that ensures an 1C is involved in relation to people whose residence is initially intended to be less than 28 days/eight weeks if the period is later extended beyond the applicable period.
	We have amended the Bill to make clear that ICs do not need to be consulted when the patient is to be detained in hospital (or otherwise required to live in the accommodation in question) under the Mental Health Act 1983. Nor will they need to be consulted about treatment which is regulated by that Act. The code will point to this exclusion.
	We will amend the code to add the 1C to the list of people for whom the code is produced and who have a duty to have regard to it.
	Chapter 12: Research
	The chapter on research will be amended to include information on changes to research governance and the role of the central office for research ethics committees from 2005.
	The code will clarify that if a deputy had no relationship with, or knowledge of, the person who lacks capacity before his appointment as deputy, then he or she should not be the person consulted about the participation of the person lacking capacity in research. We will amend the reference to the researcher's right to appeal if a carer or nominated person has advised against involving the person who lacks capacity in the research. We will clarify that the carer or nominated person has the final say. We will also clarify what is meant by terms such as negligible risk and not unduly invasive.

EDUCATION AND SKILLS

Teachers' TV Board of Governors

Ruth Kelly: I wish to announce the establishment of the Teachers' TV Board of Governors as an advisory non-departmental public body (ANDPB).
	Teachers' TV is a new digital TV channel aimed at people who work in schools. Funded by, but editorially independent of, the Department for Education and Skills (DfES), the channel will offer direct access to resources, information and training to support head teachers, teachers, governors, teaching assistants and other school staff to deliver education to the highest possible standard.
	A third party, education digital, will run the channel on behalf of DfES. They will have direct responsibility for commissioning programming, scheduling and transmission—in short, all aspects of the channel's daily operations.
	In order to ensure the channel is independent of Government, as required by the 2003 Communications Act, yet remains accountable for the public money it receives, a governance structure has been developed. This structure will be overseen by the Teachers' TV Board of Governors who will be responsible for ensuring DfES's educational outcomes are effectively translated into targets for Teachers' TV programming. The supplier's performance-related bonus will be dependent on them successfully meeting these targets.
	The Board of Governors has been established as an advisory non-departmental public body and it will act as a high-powered advisory authority that will inform DfES decisions regarding Teachers' TV. The board will produce an annual report for presentation to the Department which will also be published. It will outline the advice that the board has given DfES over the course of the year, the targets the supplier was set, the board's assessment of the supplier's performance over the previous year and the bonus that was recommended to the Department. Other matters, at the board's discretion, may also be covered in the report—for example the effectiveness of the regulatory framework in upholding the channel's editorial independence.
	Teachers' TV will launch in February 2005 and will be on-air 24 hours per day via a number of distribution outlets including digital satellite, digital cable and digital terrestrial TV. An associated Teachers' TV website will provide a broadband version of programmes and downloadable resources, an interactive TV facility will be developed by autumn 2005.
	I believe the work of the Teachers' TV Board of Governors will be invaluable in ensuring Teachers' TV delivers the maximum benefit to people who work in schools through supporting them to get the best out of themselves and their pupils.

HEALTH

NHS Foundation Trusts

John Hutton: The chairman of Monitor (whose statutory name is the independent regulator of NHS foundation trusts) announced on 4 January 2005 that, in accordance with section six of the Health and Social Care (Community Health and Standards) Act 2003, Monitor authorised the following NHS trusts as NHS foundation trusts from 1 January 2005, as part of its first group in wave 1A:
	Barnsley District General Hospitals NHS Trust
	Chesterfield and North Derbyshire Royal Hospitals NHS Trust
	Harrogate Healthcare NHS Trust
	South Tyneside Healthcare NHS Trust
	Monitor also authorised Gateshead health NHS trust as an NHS foundation trust from 5 January 2005.
	Monitor has deferred consideration of the applications from two trusts:
	Southend Hospital NHS Trust
	West Suffolk Hospitals NHS Trust
	Further decisions on both trusts may be made at a later date by Monitor.
	Two applicants withdrew their applications in order to undertake further preparation and with the intention of re-applying at a later stage:
	Nottingham City Hospitals NHS Trust
	Burton Hospitals NHS Trust
	A copy of Monitor's press notice was placed in the Library.
	Monitor's announcement brings the total number of NHS foundation trusts to 25. Monitor is considering a second group of 10 applicants in wave 1A for authorisation from 1 April 2005.

NHS Dentistry Reforms

John Reid: In my statement on 16 July 2004, Official Report, columns 89–91WS, I set out our plans for rebuilding national health service dentistry to ensure better access to NHS dental care and to improve oral health in England. There have been major developments since then and we have been taking stock of the timetable for further stages of the changes.
	In the last six months there have been significant developments on a number of fronts.
	In my earlier statement I reported that there were already 1,500 dentists in more than 750 practices working under personal dental services (PDS) pilots. The interest among dentists in moving to these new ways of working has been very considerable. I am now able to report that we have some 3,500 dentists in 1,300 dental practices working under PDS arrangements. Furthermore there are some 500 practices with applications in the pipeline. When those applications have been approved there will be some 20 per cent. of practices in PDS and the number of dentists seeking to move to the new arrangements is growing daily.
	In November we received a report from the National Audit Office in which they acknowledged that
	"there is a strong rationale for reforming NHS dentistry".
	However, they also identified risks to the successful implementation of our reforms. The NAO were particularly concerned that primary care trusts should have time to acquire the necessary skills and resources before the full commissioning of NHS dentistry was delegated to them. We are preparing guidance and additional support for PCTs. Nevertheless we recognise that this is a major new responsibility and PCTs need to be well prepared for it.
	We have made very good progress towards recruiting 1,000 whole time equivalent dentists to address access issues. The first batch of dentists from Poland have arrived in England and, following induction, will be starting work during January in the south-west, Cumbria and West Midland. Further tranches of Polish dentists will be starting at regular intervals between now and October. We have also begun recruitment activity in other European countries, including Spain and Germany. On the domestic front the NHS locally has been recruiting dentists and the "Keeping in Touch" scheme has supported dentists back to practice after a career break.
	We have addressed the backlog of people waiting to take the international qualifying exam which enables dentists from non-EU countries to practise in England. The numbers of candidates passing this Exam in 2004 was 199 compared with 81 in 2003. The Department of Health in conjunction with the General Dental Council and the Royal College of Surgeons (Edinburgh) has arranged a sitting of IQE Part A in India at the end of February for dentists who wish to work in England.
	The National Institute for Clinical Excellence issued guidance in October 2004 on recall intervals. It recommended that patients should be recalled on the basis of clinical need with intervals varying from 3–18 months. These intervals will move away from the current practice of many dentists who recall patients every six months.
	The system reform which we will be undertaking is a complex one where we have to ensure that the component parts interconnect effectively. As the NAO report indicated we have to manage the risks associated with these changes and ensure that their implementation is fully effective. We have been making rapid progress and considering when would be the optimum time to make further changes. We have decided to continue implementing some of the changes currently underway. It is important that dentists who want to move to PDS status should be able to do so as quickly as possible. Dentists also need to be able to take account of the NICE guidance in their day-to-day practice. The dental practice board and dental software suppliers also need time to make the necessary changes to information technology systems. Major changes, such as that to patient charges, need to go out for public consultation and be subject to debate in Parliament. In that context, we are considering the recommendations of the NHS dentistry patient charges working group. We also need to take account of the NAO's constructive recommendations about managing risk. For example, strategic health authorities are performance managing primary care trusts in terms of our key objectives—buying-back additional NHS capacity from existing dentists, encouraging further transfers to PDS and matching new recruits (including international ones) to vacancies in the hardest pressed areas. Through this process we can ensure that the changes which are introduced are in the best interests of patients, dentists and the NHS.
	For all these reasons, we believe more time is needed to ensure complete system reform and have therefore decided that full implementation will now take place by April 2006. A longer lead-in time will allow many more dentists to move to new ways of working in the meantime, will enable public consultation on key aspects and the parliamentary process to be fully observed and will allow primary care trusts to prepare their new roles.
	I can also confirm intention to publish for consultation the new regulations for local commissioning of primary dental services and dental charging in the summer of 2005.
	The changes which we have been making to NHS dentistry are proving to be very successful as evidenced by the high level of interest among dentists in moving to new ways of working.